Paul Callaway
Age: 77 years old male
Patient
Patient's Story (Role player’s brief)
Patient’s Story
You are Alice, a district nurse calling as part of a routine palliative care visit to Mr. Paul Callaway, a 77-year-old man with metastatic prostate cancer on palliative treatment.
During your visit today, Paul reported new and worsening pain in his left calf and foot, which started last night. He also noticed the foot looks discoloured. He is currently in pain, and you are unsure what to do next.
He has just taken 10mls of Oramorph, so he is not due another dose for 3 hours, and his next dose of Zomorph is 8 hours away. You’re worried because he’s still in a lot of pain, and you’re not sure what additional pain relief can be given safely at this point.
Only Provide the Following If Asked
You have examined him:
- Vitals are normal (BP 120/76mmHg, Pulse 92bpm, Temperature- 36.9-degree Celsius, Respiratory rate 17cpm)
- The left foot appears dark/discoloured
- No palpable pulses in the left foot.
Patient has expressed his wishes not to be admitted, no matter the context as he wants to remain at home and die in peace.
Patient’s Social History: Paul lives at home with his wife, who is also his main carer. She appears visibly stressed, and there are concerns about whether she is coping adequately with his increasing care needs. He is now mostly bed bound. He does not smoke or drink alcohol. Paul is aware of the nature of his condition and appears to be preparing for the end of life.
Ideas: You’re concerned this might be a DVT or some sort of vascular issue
Concerns: He is now bed bound due to pain, and you’re unsure whether his morphine dose can be safely increased
Expectations: You are calling for guidance from the GP on the next best steps.
Say NO to any other questions asked outside of the details already provided in the scenario
Question for the GP
“What can I give him right now for pain relief? He’s just taken 10ml of Oramorph and isn’t due another dose for 3 hours, and his Zomorph isn’t due for 8 hours. He’s still in a lot of pain, and I’m unsure what I can safely give him at this point.”